Analysis of postpartum reversible cerebral vasoconstriction syndrome in China

Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare clinical syndrome accompanying with severe headache as its main symptom. Postpartum reversible cerebral vasoconstriction syndrome (PPRCVS) refers to RCVS occurring in the puerperium, in which it has a low incidence, and that is easily missed diagnosed and misdiagnosed in clinical practice.By searching in CNKI and Wanfang databases, 9 published articles reported PPRCVS were found, totally including 12 cases with PPRCVS. The clinical data of these 12 cases were accordingly analyzed and summarized. The characteristics of these cases were compared with those reported in other countries, and eventually the clinical characteristics of Chinese PPRCVS patients were summarized.The clinical characteristics of Chinese PPRCVS patients were basically as same as those found in other countries, while the onset age was earlier, PPRCVS often occurred earlier after delivery, with higher proportions of concomitant symptoms and abnormal laboratory and imaging examinations; moreover, and fewer patients were diagnosed by digital subtraction angiography (DSA).

Reversible cerebral vasoconstriction syndrome: literature review

“…It can affect any age group, including children [ 10 ] and young adolescents [ 7 ]. However, it primarily affects individuals between 20 and 50 years of age [ 1 , 2 , 9 – 11 , 13 , 20 , 38 , 39 ], with a peak around 42 years of age [ 7 , 40 ]. It is more common in women than in men, with incidence rates of 2.6:1 to 10:1 [ 1 , 5 – 7 , 10 , 12 , 17 , 20 , 28 , 41 – 43 ].…”

“…Regarding CCBs, intravenous and oral nimodipine, with a dosage of 30–60 mg every 4 h [ 64 ], is best described in the improvement of headache [ 74 ] in 64–83% of patients [ 1 , 11 , 17 , 75 ]. In the form of an infusion of this drug, the dosage of one to two mg/h has been described.…”

“…The other choices of CCBs are verapamil and nicardipine [ 11 , 76 ] orally and for 4–8 weeks [ 46 ]. In the literature, intra-arterial (IA) verapamil has been reported in a patient with RCVS refractory to treatment, causing a profound reversal of vasospasm.…”

Ophthalmological symptoms in a patient with reversible cerebral vasoconstriction syndrome: a case report

“…RCVS is an acute and self-limiting disease commonly accompanied by acute, severe headache. The most significant contributor to RCVS is being postpartum [ 10 – 12 ], with hypertension also reported to be a contributing factor [ 13 ]. The present patient suffered from both hypertension and severe headache at 2 days after her first childbirth.…”

“…Because of visual deficits, the patient presented to our clinic instead of visiting either the emergency room or her obstetrician. Blurred vision has been previously reported to be one of the clinical manifestations of RCVS that is due to brain lesions [ 8 , 10 , 12 , 13 , 17 ]. Although homonymous hemianopsia was previously reported in a case examined using a confrontation visual field test [ 17 ], detailed ocular findings have not been reported in other prior RCVS cases.…”